| Brand Name | PrimeTaper EV Ø3.6 x 9mm OS |
| Common Device Name | implant, endosseous, root-form |
| Manufacturer (Section D) |
| Dentsply Implants Manufacturing GmbH |
| rodenbacher chaussee 4 |
| 63457 hanau |
| hessen |
| GM |
|
| Manufacturer (Section G) |
| Dentsply IH AB |
| aminogatan 1 |
| s-431 21 molndal vastra gotala |
| |
|
SW
|
|
| Manufacturer Contact |
|
dan
eagar
|
| 221 w. philadelphia st. |
| suite 60w |
| york, PA 17401
|
|
+1(717)845-7511
|
|
| MDR Report Key | 50656103 |
| Report Number | 3013111692-2026-40197 |
| Device Sequence Number | 21204208 |
| Product Code |
DZE
|
| UDI-Device Identifier | 07392532276644 |
| UDI-Public | 07392532276644 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | JA |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Implanted Year | 2024 |
| Device Explanted Year | 2026 |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Foreign,Health Professional,Distributor |
| Initial Reporter Occupation |
Dentist
|
| Type of Report
| Initial |
| Report Date (Section B) |
09/07/2026 |
| 1 Device was Involved in the Event |
|
| 1 Patient was Involved in the Event |
|
| Is this an Adverse Event Report? |
Yes
|
| Is this a Product Problem Report? |
No
|
| Operator of Device |
Health Professional
|
| Device Catalogue Number | 68011091 |
| Device Lot Number | 537218 |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 08/08/2026 |
| Initial Report FDA Received Date | 09/07/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Is the Device Labeled for Single Use? (Y/N) |
No
|
Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N) |
No
|
| Usage of Device |
Unknown
|
| Patient Sequence Number | 1 |
| Outcome Attributed to Adverse Event |
Required Intervention;
Other;
|
| Patient Sex | Unknown |